2型糖尿病合并痛风性关节炎患者单核细胞高密度脂蛋白胆固醇比值与非酒精性脂肪肝关系研究

Correlation analysis of monocyte/high-density lipoprotein cholesterol ratio and NAFLD in patients with type 2 diabetes mellitus andgoutyarthritis

目的 探讨2型糖尿病(T2DM)合并痛风性关节炎(GA)患者单核细胞(MONO)高密度脂蛋白胆固醇(HDL-c)比值(MHR)与非酒精性脂肪肝(NAFLD)的关系,分析NAFLD发生的影响因素。方法 选取2019年12月至2022年12月在安徽中医药大学第一附属医院内分泌科住院治疗的T2DM合并GA患者214例,根据是否合并NAFLD分为NAFLD组、非NAFLD组,比较两组一般资料、理化指标,NAFLD组根据胰岛素抵抗指数(HOMA-IR)水平进行亚组分析;根据MHR三分位数分为Q1MHR、Q2MHR、Q3MHR三组,比较HOMA-IR水平的差异,以及各组NAFLD的发生率;logistic回归分析T2DM合并GA患者NAFLD的危险因素,受试者工作特征曲线(ROC)评估MHR在T2DM合并GA患者中NAFLD的临床价值。结果 与非NAFLD组比较,NAFLD组Fins、HOMA-IR、AST、ALT、TG、CRP、MONO、MHR均升高(P<0.05),HDL-c降低(P<0.05)。NAFLD组中,与HOMA-IR<2.5亚组相比,HOMA-IR≥2.5亚组BMI、WHR、FPG、SUA、TC、TG、LDL-c、CRP、MONO、MHR水平升高(P<0.05)。根据MHR三分位数分组,HOMA-IR水平在Q3MHR[4.67(2.93,7.29)]亚组明显高于Q1MHR[3.44(1.85,4.89)]、Q2MHR[4.15(2.13,6.03)]亚组(P<0.05),NAFLD发生率比较,Q3MHR亚组高于Q1MHR、Q2MHR亚组(74.51%比23.08%、39.22%,P<0.05),Q2MHR亚组高于Q1MHR(39.22%比23.08%,P<0.05)。多因素logistic回归分析显示,LDL-c、CRP、MHR是T2DM合并GA患者发生NAFLD的危险因素(P<0.05)。ROC曲线结果显示,MHR预测T2DM合并痛风性关节炎患者发生NAFLD的曲线下面积(AUC)为0.759,灵敏度72.9%,特异度71.4%。结论 MHR与T2DM合并痛风性关节炎患者NAFLD发生相关,MHR对T2DM合并痛风性关节炎患者NAFLD发生有一定的预测价值。

ObjectiveTo investigate the relationship between the ratio of monocyte to high-density lipoprotein cholesterol(MHR)and non-alcoholic fatty liver disease(NAFLD)in patients with type 2 diabetes mellitus(T2DM)and gouty arthritis(GA),and to analyze the influencing factors of NAFLD.Methods A total of 214 patients with T2DM and GA hospitalized in The First Clinical Medical School of Anhui University of Chinese Medicine from December 2019 to December 2022 were enrolled,who were divided into NAFLD group and non-NAFLD group according to whether they had NAFLD or not.General data and laboratory indicators of the two groups were compared.Subgroup analysis was performed in NAFLD group according to HOMA-IR level.They were divided into Q1MIR,Q2MHR and Q3MHR groups according to the MHR tertile,and the differences in HOMA-IR levels and the incidence of NAFLD among the QIMHR,Q2MR and Q3u groups were compared.Logistic regression analysis was performed to analyze the risk factors of NAFLD in T2DM patients with GA,and Receiver Operating Characteristic Curve(ROC)was used to evaluate the clinical value of MHR in T2DM patients with GA.Results Compared with non-NAFLD group,Fins,HOMAIR,AST,ALT,TG,CRP,MON and MHR in NAFLD group were increased(P<0.05),while HDL-C decreased(P<0.05).In NAFLD group,compared with HOMA-IR<2.5 subgroup,BMI,WHR,FPG,SUA,TC,TG,LDL-c,CRP,MON and MHR levels in HOMA-IR≥2.5 subgroup were increased(P<0.05).According to the MHR tertile,the level of HOMA-IR in Q3wur[4.67(2.93,7.29)]subgroup was significantly higher than that in Q1ur[3.44(1.85,4.89)]and Q2um[4.15(2.13,6.03)]subgroup(P<0.05).The incidence of NAFLD in Q3wu subgroup was higher than that in Q1um and Q2ur subgroups(74.51%us.23.08%,39.22%,P<0.05)and Q2ur subgroup was higher than Q1un subgroup(39.22%us.23.08%,P<0.05).Multivariate Logistic regression analysis showed that LDL-c,CRP and MHR were risk factors for NAFLD in T2DM patients with GA(P<0.05).ROC curve results showed that the area under the curve(AUC)of MHR in predicting NAFLD in T2DM patients with GA was 0.759,with a sensitivity of 72.9%and a specificity of 71.4%.Conclusion MHR is correlated with the occurrence of NAFLD in patients with T2DM and GA.Moreover,MHR has some predictive value for the occurrence of NAFLD in T2DM patients with gouty arthritis.